1. Report an adverse drug event to the FDA Medwatch Progam
2. Write a letter to one or more “key contacts”:
Instructions:
- First, decide who you want to contact and research for their contact information. Some ideas for who to contact include: your governor, your state senators and representatives, your state medical board, and other “key contacts” like the commissioner of health/secretary of health and human resources, etc.
- Next, write a brief version of your story that you will include as a part of the letter you are sending. Please keep the story and the overall email concise, as most legislators/regulating bodies will not have time to read overly long messages.
- When writing, please follow the tone of the sample letter that is provided below: professional, informative, civil and use appropriate language that is representative of W-BAD’s objectives/mission. Feel free, though, to edit the sample letter to content of your choice.
- Compose a separate email to each person you’re contacting (as you want them to be somewhat personal and addressed specifically to each person). All of the emails that you send can be identical though, unless you want to compose slightly different ones specifically tailored to who you are writing.
- Give the e-mail a relevant subject line
- Read over everything to be sure you’ve included everything you wished to include and removed any instructions that weren’t meant to go to the email recipient.
- Send the e-mails.
Sample Letter:
- Change anything in red to your personal information
- Every letter you send will include the black text
- Include the purple text (with the black text, but not the green) only when writing the Board of Medicine
- Include the green text (with the black text, but not the purple) only when writing the Governor.
Email subject: Attn: Name of individual you are contacting re: benzodiazepine/Z-drug legislation
Dear [title/name of who this email will be sent to],
I am writing to ask that you review an informed-consent Bill out of Massachusetts that was given an extension in Committee following a hearing—S.1092, ‘An Act Relative to Benzodiazepine and Nonbenzodiazepine Hypnotics’ S.1092—and then consider drafting/supporting identical regulations and legislation in [your state’s name]. Benzodiazepines have been widely prescribed drugs throughout the world for about sixty years. They are often prescribed for insomnia and anxiety but can be prescribed for an array of other conditions. You may be familiar with some of their brand names such as Valium, Xanax, Ativan, and Klonopin—as well as sleeping pills like Ambien and Lunesta, which act similarly to benzodiazepines and, thus, carry the same risks/harms. Note: Hawaii also passed a benzodiazepine Bill which addressed limiting benzodiazepine prescriptions, although it mainly focused on opiates and lacked important language around informed consent for new benzodiazepine prescriptions as well as language that would protect those already physically dependent on long-term prescribed benzodiazepines.
The issue is that, more often than not, benzodiazepines are being prescribed by physicians and other medical providers for longer than the recommended 2-4 week guidelines, with little to no information being shared with the patient (no informed consent) about the potential adverse effects and withdrawal that can result from compliant use past this time frame. Once physically dependent, patients find they cannot stop taking the medication—even when they want to—without a long taper and debilitating withdrawal symptoms. Sometimes, the withdrawal is severe (so severe it can sometimes result in suicide) and long-lasting (protracted); some reported cases require many years to withdraw via taper or for the nervous system to fully repair post-cessation. This leads to a litany of socioeconomic issues, as the patient is often rendered unable to work or to be a productive member of society like they were prior to benzodiazepine prescription. For example, many people suffering from benzodiazepine withdrawal syndrome are forced to collect social security disability due to its severity and duration.
[insert your very BRIEF story/personal testimony]
A bill identical or similar to S.1092 in Massachusetts in (insert your state’s name) would simply require that patients receive informed consent from their medical professionals (doctors, PAs, NPs, etc.) before a benzodiazepine or non-benzodiazepine is prescribed so that the patient can be fully educated on the risks and potential harms associated with prolonged use of these drugs prior to taking them. This small requirement could be the difference between life and death for many and would eliminate much undue suffering and socioeconomic cost. A similar bill should also require a limit on the timeline for which new benzodiazepines/Z-drug prescriptions can be prescribed (e.g., 10 days supply or less, with no refills) as well as language making clear that those who are already dependent on benzodiazepines should be allowed to either 1. Make the decision to remain on the drug (no one who is already iatrogenically physically dependent should be forced against their will to withdraw) or 2. Choose to slowly taper off at a rate and speed that they, the patient, deem comfortable. I ask you to please consider drafting/supporting similar legislation and follow closely behind Massachusetts’ trailblazing efforts to recognize the need for regulations around this very important issue.
[This section in purple—in addition to the black text—is to be included in your email to the Board of Medicine only (do not include this to legislators, as it is too long and irrelevant)]: As members of the Board of Medicine, you have all taken an oath to “first, do no harm”—which means you have a duty to protect your patients in this state. As you most likely already know, there are currently bills pending/passed in many states calling for stricter regulations of opioid drugs. It makes little sense to regulate opioids and to ignore that benzodiazepines absolutely require similar regulations, although benzodiazepine regulations should be slightly different (as detailed above). Benzodiazepine withdrawal syndromes are far more dangerous and long-lasting than opiates. Moreover, the clinical effectiveness of these drugs is a question of much debate and there is growing evidence that their chronic prescription is a matter of grave concern for health professionals, legislators and, most importantly, patients. These drugs were intended for short-term use only, but the medical community has created an epidemic of physically dependent long-term patients who are stuck taking a class of drug that has the most debilitating withdrawal reaction in all of medicine. The American Psychiatric Association has known since at least the 1980s that these drugs caused these issues, as they organized a Task Force about them. Unfortunately, the problem still persists and is getting worse.If the legislators drag their feet on drafting a bill or cannot get a bill passed, I suggest that the Board of Medicine, along with the State Governor, pass physician-decided regulations and bypass legislators altogether. This was done In February 2017, when the Virginia Board of Medicine created new opioid prescription guidelines, so we know it’s a viable means to get state drug regulations passed. Medical prescribers, having been initially misled for years by pharma companies that benzodiazepines/Z-drugs were “non-addictive,” are largely responsible for the mass and long-term prescribing mess that we find ourselves in; it seems only right that they take some responsibility in cleaning it up. Furthermore, all specialties of medicine should support benzodiazepine regulation as the drugs often lead to a plethora of system-wide symptoms (due to “breakthrough symptoms” from tolerance and interdose withdrawal in long-term use or toxicity) for which patients often wind up seeking out specialists (cardiologists for heart palpitations, neurologists for dizziness, rheumatologists for rashes, orthopedists for muscle spasticity, gastroenterologists for GI distress, etc.). Sadly, the benzodiazepine being the cause of their distress and newly emerging symptoms are often overlooked as the direct cause and the patients are often subjected to an expensive battery of tests, misdiagnoses, and/or unnecessary poly-drugging as a result.]
[(Include this section in green—in addition to the black—only when writing the Governor:)] If legislators drag their feet on drafting a bill or cannot get one passed, I suggest that the Board of Medicine, along with the State Governor, pass physician-decided regulations and bypass legislators altogether.]
If time allows, please visit the following websites to learn more about this most urgent and serious problem:
Thank you for your time and consideration regarding this matter.
Your full name
Location (City, State, Zip Code)
Email/Phone Number